Long-term efficacy of repeated daily prefrontal transcranial magnetic stimulation (TMS) in treatment-resistant depression
Major Finding:
For patients with Treatment-Resistant Depression (TRD), transcranial magnetic stimulation (TMS) can be an effective treatment for maintaining remission with a relatively low relapse rate, especially when followed by continued treatment protocols, either pharmacological or additional TMS sessions.
Let’s take a closer look:
TMS has been proven to be an effective treatment for individuals with TRD as it significantly minimizes depressive symptoms and episodes. But do these results last beyond the TMS treatment period? If someone finishes their TMS sessions, do they have to worry about their depressive symptoms returning?
The Problem:
By the time patients pursue TMS treatment, it is more than likely that they have tried at least one other antidepressant treatment. TMS is a viable option for Treatment-Resistant Depression, but many patients want to know if the results of TMS will be long-lasting. The rates of remission and relapse for TMS treatment can help inform and encourage patients to try TMS treatment if they feel that their symptoms will subside for the long term, not just during the period of acute TMS treatment.
Study Details:
This study consisted of 199 patients who met the DSM-IV criteria for Major Depressive Disorder and who also demonstrated past depression treatment resistance. The study had 3 main phases to investigate the durability and duration of TMS treatment for depressive symptoms:
1) A randomized control trial of TMS treatment.
2) An open-label trial of TMS treatment who did not achieve remission in the first phase or who were in the control group.
3) Long-term follow-up of patients who achieved remission of depressive symptoms in Phase 1 or Phase 2
In the follow-up phase of the study, patients were followed for 6 months but only data from the first 3 months post treatment were analyzed due to low retention. The first assessment of treatment durability was over a 4-week taper period where patients gradually tapered their TMS treatment. The efficacy and acute durability of TMS treatment was evaluated over an 8 week period after the initial taper period. Symptoms were assessed at each monthly visit using the Hamilton Depression Rating Scale (HDRS-24).
Results:
After a 3-month follow-up, 50/61 participants remained in the trial. Of those participants, 39 of them remained in remission (58%) with a HDRS-24 score of 10. 2 of the 50 who remained were partial responders (HDRS-24 score reduction of >50% from baseline), and one of the 50 who remained met criteria for total relapse.
The Conclusion
Transcranial magnetic stimulation (TMS) demonstrates substantial efficacy in maintaining remission for patients with treatment-resistant depression (TRD), with a low relapse rate observed over a 3-month follow-up period. Continued treatment, whether through additional TMS sessions or pharmacotherapy, appears to play a critical role in sustaining these positive outcomes. However, for acute relief of depressive symptoms and relief thereafter, TMS treatment is durable and effective.
CITATION
Mantovani A, Pavlicova M, Avery D, Nahas Z, McDonald WM, Wajdik CD, Holtzheimer PE 3rd, George MS, Sackeim HA, Lisanby SH. Long-term efficacy of repeated daily prefrontal transcranial magnetic stimulation (TMS) in treatment-resistant depression. Depress Anxiety. 2012 Oct;29(10):883-90. doi: 10.1002/da.21967. Epub 2012 Jun 11. PMID: 22689290; PMCID: PMC4413472.